Provider Demographics
NPI:1063527901
Name:JOHN S DEMARE DO PC
Entity type:Organization
Organization Name:JOHN S DEMARE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-247-6020
Mailing Address - Street 1:13700 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2702
Mailing Address - Country:US
Mailing Address - Phone:586-247-6020
Mailing Address - Fax:586-247-7048
Practice Address - Street 1:13700 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2702
Practice Address - Country:US
Practice Address - Phone:586-247-6020
Practice Address - Fax:586-247-7048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E01378OtherBX
0N87300Medicare ID - Type Unspecified